Prophylactic Incisional Negative Pressure Wound Therapy Versus Standard Dressing after Major Lower Extremity Amputation: A Randomised Controlled Trial

Vaddavalli, Venkata Vineeth; Savlania, Ajay; Behera, Arunanshu; Rastogi, Ashu; Kaman, Lileshwar; Abuji, Kishore

doi:10.1016/j.ejvs.2022.07.057

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…After screening titles and abstracts based on the selection criteria, 67 articles were excluded for not aligning with the study content. Full‐text review of the remaining 49 articles resulted in the inclusion of 11 RCTs, 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 involving a total of 1597 vascular surgery patients, with 784 in the NPWT group and 813 in the control group. The basic characteristics of the included literature are presented in Table 1 , and the risk assessment of the literature is depicted in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

RETRACTED: Effects of negative‐pressure wound therapy in the prevention of surgical‐site wound infection after vascular surgery: A meta‐analysis

Yu,

Xie,

et al. 2024

International Wound Journal

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This meta‐analysis systematically evaluates the impact of negative‐pressure wound therapy (NPWT) on surgical‐site wound infection after vascular surgery. A comprehensive computerized search was conducted, from database inception to November 2023, in PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases for randomized controlled trials (RCTs) on the application of NPWT in vascular surgery. Two researchers independently screened the literature, extracted data, and conducted quality assessments based on inclusion and exclusion criteria. Data analysis was performed using RevMan 5.4 software. A total of 11 RCTs involving 1597 vascular surgery patients were included. The analysis revealed that the application of NPWT in vascular surgery significantly reduced the incidence of wound infections (OR = 0.43, 95% CI: 0.32–0.58, p < 0.001) and complications (OR = 0.40, 95% CI: 0.27–0.58, p < 0.001). Additionally, NPWT was found to decrease the occurrence of both superficial wound infections (OR = 0.63, 95% CI: 0.36–1.12, p = 0.12) and deep wound infections (OR = 0.47, 95% CI: 0.19–1.16, p = 0.10), although these differences were not statistically significant. This study indicates that NPWT, compared with conventional treatment methods, has significant advantages in preventing postoperative wound infections and complications in vascular surgery patients and is therefore worthy of widespread clinical adoption.

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Section: Resultsmentioning

confidence: 99%

RETRACTED: Effects of negative‐pressure wound therapy in the prevention of surgical‐site wound infection after vascular surgery: A meta‐analysis

Yu,

Xie,

et al. 2024

International Wound Journal

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“…There is certainly room for improvement in this area, and a recently published randomized trial using incisional negative pressure wound therapy has shown a reduction of incidence of surgical site infection and improved stump healing. 25 Hopefully, there will be consistent results in similar future randomized trials in patients undergoing major amputation due to ALI.…”

Section: Discussionmentioning

confidence: 77%

Management of Acute Lower Limb Ischemia Without Surgical Revascularization – A Population-Based Study

Acosta,

Kulezic,

Zarrouk

et al. 2023

Vasc Endovascular Surg

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Objectives To evaluate outcomes of management without surgical revascularization in patients with acute lower limb ischemia (ALI) in a population-based setting. Design Retrospective observational population-based study. Materials Patients from Malmö, Sweden, hospitalized for ALI between 2015 and 2018. Methods In-hospital, surgical, radiological, and autopsy registries were scrutinized for descriptive data on ALI patients managed by endovascular and open vascular surgery, conservative vascular therapy, primary major amputation, and palliative care. Results Among 161 patients, 73 (45.3%) did not undergo any operative revascularization. Conservative vascular therapy, primary amputation, and palliative care were conducted in 25 (15.5%), 26 (16.1%), and 22 (13.7%) patients, respectively. Conservatively treated patients had Rutherford class ≥ IIb ischemia and embolic occlusion in 33% and 68% of cases, respectively. Their median C-reactive protein level at admission was 7 mg/L (interquartile range 2 – 31 mg/L). Among conservatively treated patients, anticoagulation therapy in half to full dose was given to 22 (88%) patients for six weeks or longer, and analgesics in low or moderate doses were given to twelve (48%) patients at discharge. The major amputation rate at 1 year was 8% among conservatively treated patients, and four patients with foot embolization had not undergone amputation at 1 year. Conclusion Patients selected for initial conservative therapy of ALI with anticoagulation alone may have a good outcome, even when admitted with Rutherford class IIb ischemia. A low C-reactive protein level at admission seems to be a favorable marker when choosing conservative therapy. A prospective, preferably multicenter, study with a predefined protocol in these conservatively treated patients is warranted to better define the dose and length of anticoagulation therapy.

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“…Lambrechts et al performed a meta-analysis comparing the use of incisional NPWT with a standard dressing in spine surgery and found decreased rates of SSI with use of NPWT but no difference in the odds of reoperation for wound debridement 23 . Additionally, a recent randomized controlled trial on the use of incisional NPWT following major lower-extremity amputations in patients with peripheral artery disease also showed decreased odds of SSI and decreased time to complete residual limb healing 24 . In the arthroplasty literature, NPWT has been shown to decrease the risk of SSI in revision cases, but this association has not yet been shown in primary arthroplasty 25,26 .…”

Section: Discussionmentioning

confidence: 96%

Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Surgical Site Infections?

LiBrizzi

Sabharwal

Forsberg

et al. 2023

Journal of Bone and Joint Surgery

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Background: Surgical site infections (SSIs) represent a major complication following oncologic reconstructions. Our objectives were (1) to assess whether the use of postoperative drains and/or negative pressure wound therapy (NPWT) were associated with SSIs following lower-extremity oncologic reconstruction and (2) to identify factors associated with the duration of postoperative drains and with the duration of NPWT. Methods: This is a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial, a multi-institution randomized controlled trial of lower-extremity oncologic reconstructions. Data were recorded regarding the use of drains alone, NPWT alone, or both NPWT and drains, including the total duration of each postoperatively. We analyzed postoperative drain duration and associations with tourniquet use, intraoperative thromboprophylaxis or antifibrinolytic use, incision length, resection length, and total operative time, through use of a linear regression model. A Cox proportional hazards model was used to evaluate the independent predictors of SSI. Results: Overall, 604 patients were included and the incidence of SSI was 15.9%. Postoperative drains alone were used in 409 patients (67.7%), NPWT alone was used in 15 patients (2.5%), and both postoperative drains and NPWT were used in 68 patients (11.3%). The median (and interquartile range [IQR]) duration of drains and of NPWT was 3 days (IQR, 2 to 5 days) and 6 days (IQR, 4 to 8 days), respectively. The use of postoperative drains alone, NPWT alone, or both drains and NPWT was not associated with SSI (p = 0.14). Increased postoperative drain duration was associated with longer operative times and no intraoperative tourniquet use, as shown on linear regression analysis (p < 0.001 and p = 0.03, respectively). A postoperative drain duration of ≥14 days (hazard ratio [HR], 3.6; 95% confidence interval [CI], 1.3 to 9.6; p = 0.01) and an operative time of ≥8 hours (HR, 4.5; 95% CI, 1.7 to 11.9; p = 0.002) were independent predictors of SSI following lower-extremity oncologic reconstruction. Conclusions: A postoperative drain duration of ≥14 days and an operative time of ≥8 hours were independent predictors of SSI following lower-extremity oncologic reconstruction. Neither the use of postoperative drains nor the use of NPWT was a predictor of SSI. Future research is required to delineate the association of the combined use of postoperative drains and NPWT with SSI. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Prophylactic Incisional Negative Pressure Wound Therapy Versus Standard Dressing after Major Lower Extremity Amputation: A Randomised Controlled Trial

Cited by 7 publications

References 6 publications

RETRACTED: Effects of negative‐pressure wound therapy in the prevention of surgical‐site wound infection after vascular surgery: A meta‐analysis

RETRACTED: Effects of negative‐pressure wound therapy in the prevention of surgical‐site wound infection after vascular surgery: A meta‐analysis

Management of Acute Lower Limb Ischemia Without Surgical Revascularization – A Population-Based Study

Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Surgical Site Infections?

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